Provider Demographics
NPI:1003829268
Name:WU, HENRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133-38 41ST ROAD
Mailing Address - Street 2:SUITE CO1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3782
Mailing Address - Country:US
Mailing Address - Phone:917-838-9873
Mailing Address - Fax:718-886-2086
Practice Address - Street 1:133-38 41ST ROAD
Practice Address - Street 2:SUITE CO1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3782
Practice Address - Country:US
Practice Address - Phone:718-886-9086
Practice Address - Fax:718-886-2086
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006109213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02703675Medicaid
NY6204090001Medicare NSC
NY01639IMedicare ID - Type UnspecifiedGHI MEDICARE
NY02703675Medicaid
NYPK0921Medicare PIN